Role of the Primary Care Physician in Occupational and Environmental Medicine (1988) / Chapter Skim
Currently Skimming:
Recommended Interventions in the Education of Future Physicians
Recommended Interventions in the Education of Future Physicians
Pages 47-62
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From page 47... ...
EDUCATION OBJECTIVES FOR UNDERGRADUATE MEDICAL EDUCATION Undergraduate medical education should lay the foundation for training physicians to incorporate occupational and environmental factors into the etiologic investigation of disease. Because occupational and environmental medicine is largely based on general preventive medicine principles, didactic and clinical training that provides an adequate focus on preventive activities of all types and in relation to all organ systems is key to achieving the minimal competencies iclentified in this section.
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From page 48... ...
EDUCATIONAL OBIECr~FS FOR GRADUATE MEDICAL EDUCATION With the expectation that the undergraduate educational objectives described have been achieved, the overall goal of residency training is to further prepare physicians to recognize, diagnose, and treat occupational and environmental health conditions and risks pertinent to their current and future practice. The knowledge and skills needed for the successful incorporation of occupational and environmental factors into clinical practice will necessarily vale by specialty and subspecialty area.
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From page 49... ...
Internal Medicine and Family Practice The committee believes that the funclamental tool to be mastered at the residency level is the occupational and environmental health history; trainees should team to take both an occupational and environmental screening history and a more in~epth history directed by the indiviclual's complaints and findings. General toxicologic principles, similar to those reamed in pharmacology, should be sufficiently understood that they can be applied to the individual patient.
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Internal medicine and family practice residency programs should teach the specific skills related to care for patients with work-related diseases and injuries. These skills include assessing impairment floss of bodily function)
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The NCTR is almost totally an intramural program. The CEH and ATSDR have taken the traditional CDC view of focusing their efforts inhouse or at state health departments, with minimal interaction with academic medical centers.
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From page 52... ...
Other NTH components, particularly the National Cancer Institute and the National Heart, Lung, and Blood Institute, also have extramural research support in the area of environmental or occupational health. As a result of the direction of NIH activities, the departmental chair or dean
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From page 53... ...
The situation of an inadequate funding base to support academic programs mirrors the problem faced by medical school preventive medicine or public health departments. Most other medical school departments or divisions have a research mission represented at the NIH or a clinical mission considered necessary for a tertiary care medical center.
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Identification and prevention of such effects have become more and more a part of occupational health at the modern workplace. The process of risk assessment, a central part of environmental medicine, is also important for occupational medicine.
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Graduate Medical Education To a large degree, the same barriers identified above for undergraduate medical education also create deficiencies in primary care and specialty graduate training, and the same solutions apply. Most importantly, the dearth of faculty with specialty interests in occupational and environmental medicine and the ir~adequate training in these areas of current faculty responsible for educating primary care physicians contribute to the omission of occupational and environmental factors in etiologic investigations of disease.
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From page 56... ...
By recognizing the fact that most primary care residency programs will not be able to support full-time trained specialists in this field, funding should also be made available to support individuals with demonstrated clinical and teaching excellence in internal medicine and family practice who seek additional training and experience in occupational and environmental medicine. Such training should be obtained at academic centers with demonstrated excellence in the field.
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From page 57... ...
The American Board of Internal Medicine and the American Board of Family Practice, in cooperation with the Arnencan Board of Preventive Medicine, should consider this option. Current specialty certification in occupational medicine is limited to satisfying board eligibility and certifying examination criteria established by the American Board of Preventive Medicine (1982)
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From page 58... ...
Examples include questions about lead poisoning in pediatrics, workplace impact on reproductive functions in obstetrics and gynecology, occupational medicine problems in internal medicine, and occupational health problems in preventive medicine. Whenever possible, questions should probe for information about the relationship of toxins to occupational or environmental exposures.
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medical schools do not have departments of public health or preventive or community medicine that might otherwise be expected to take the lead in teaching occupational en c! environmental medicine using their own curriculum time.
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, which funds primary care training grants, currently excludes ambulatory rotations in occupational medicine from meeting its requirements for substantive time in continuity of care. Recognition of ambulatory occupational medicine as a continuity of care experience in residency programs would help overcome this barrier to resident narucination chat HRSA imposes.
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From page 61... ...
An increasing number of internal medicine and family practice residency training programs include practice management as part of training. Because occupational health care delivery invokes special financial, legal, and ethical considerations, the committee recommends that these aspects of providing occupational health services be addressed in such training.
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From page 62... ...
~ 771 T _~ 1 have often wondered how so noxious a dust can come from the grain as wholesome as wheat, and ~ began to suspect that in that dust there must lurk minute worms imperceptible tro our senses and that they are set in motion fly the sifting and measuring of the grain and broadcast by the air; then they readily adhere to the skin and excite that great heat and itching all over the body.
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